Search

The incidence of contrast-induced nephropathy (CIN) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was previously reported to be as high as 19%. Iso-osmolar contrast has frequently been used for populations at high risk for CIN, but a recent meta-analysis did not show a significant benefit of using iso-osmolar contrast in preventing CIN. The aim of our study is to evaluate the impact of iso-osmolar contrast use in patients undergoing emergent PCI. We performed a retrospective analysis of patients who underwent primary and rescue PCI for STEMI. The PCI strategy, including the contrast choice, was left at the discretion of the operator. CIN was defined as an increase in creatinine of more than 0.5 mg or 25% from the baseline within 72 hours. Among 212 patients, CIN was seen in 33 patients (16%). Patients who received iso-osmolar contrast were older, and included more patients at risk for CIN. The incidence of CIN was 14% in the low-osmolar contrast group and 17% in the iso-osmolar contrast group (P=.799). After logistic regression analysis, CIN was seen more frequently in patients who had lower ejection fraction, post-PCI TIMI flow <3, and lower hemoglobin. The use of iso-osmolar contrast was not associated with a lower incidence of CIN in patients undergoing emergent PCI for STEMI.

Objectives: Our purpose was to describe the contemporary utilization, clinical outcomes and complication rates of intra-aortic balloon pump (IABP) therapy in this current age., Background: IABP use and outcomes, in the setting of modern antiplatelet therapy and primary percutaneous coronary intervention and the use of drug-eluting stents as we know them today, have not been clearly established., Methods: We performed a retrospective cohort study by collecting detailed clinical and device data from all 150 consecutive patients who received IABP therapy in our institution between 2004 and 2009., Results: Thrombocytopenia occurred in 50%, fever in 36%, bleeding in 27%, and vascular embolic events in 1%. Thrombocytopenia was the most common adverse event and was not significantly associated with the use of antiplatelet agents. The presence of diabetes mellitus, elevated white blood cells at presentation, and longer duration of IABP were significantly associated with the development of fever. Furthermore, those who developed fever had higher in-hospital mortality (31% versus 16%; p = 0.0487)., Conclusions: In this contemporary cohort of IABP patients, complication rates of thrombocytopenia, fever and bleeding were relatively high but similar to prior studies, even in this current era of revascularization and antiplatelet medications.

Although the provisional stenting technique to treat coronary bifurcation lesions is the preferred method, many bifurcation lesions still require a two-stent technique to optimize the result and clinical outcome. This manuscript summarizes the tips and tricks of bifurcation stenting with cases illustrations. As interventionists are encountering more complex and difficult cases, one may find the tips and tricks in this manuscript helpful in daily practice.

Radial artery pseudoaneurysm is an extremely rare complication associated with transradial catheterization. We report 2 cases of pseudoaneurysm of the radial artery that were successfully treated using the Terumo TR band. We believe that the safety, efficiency, speed and minimal invasiveness of this method make it feasible for use as a treatment for peripheral pseudoaneurysm in such patients.

Myocardial bridging is a common congenital coronary anomaly that is clinically silent in the majority of cases. Case reports suggest myocardial ischemia and infarction can be caused by myocardial bridging. The proposed mechanisms by which myocardial bridging causes myocardial ischemia include compromised coronary blood flow, endothelial dysfunction, thrombus formation and a strong association with coronary vasospasm. We reported a case of myocardial infarction caused by both myocardial bridging and coronary vasospasm. We reviewed the literature and suggest that coronary stenting may have a role in treating myocardial ischemia due to myocardial bridging and coronary spasm that is refractory to medical management.

Simultaneous thrombosis of multiple epicardial coronary arteries is an uncommon clinical finding in ST-segment elevation myocardial infarction (STEMI). We describe a 37-year-old male present with inferior wall STEMI who was found to have large thrombi in both the right coronary artery (RCA) and the left anterior descending artery (LAD). We reviewed 23 patients with multivessel thrombosis in acute myocardial infarction in the literature. The mean age of patients was 53 +/- 14 years (32-82 years); 74% were males, and most patients had multiple risk factors for coronary artery disease. The LAD (78%) and RCA (87%) were the arteries involved for most patients. Aspiration thrombectomy was used in 3 cases. Though it is rare, STEMI with multiple culprit arteries can occur, and it is crucial to recognize this condition to determine the proper treatment, since most of these patients are critically ill.

The formation of coronary aneurysms and pseudoaneurysms are a rare but previously described complication after percutaneous coronary intervention (PCI). We present a unique case of the development of a giant coronary aneurysm after placement of a heparin-coated stent. A 79-year-old female who had PCI to the left anterior descending coronary artery (LAD) using a heparin-coated stent three years previously underwent cardiac catheterization. Coronary angiography revealed a giant aneurysm measuring 19 x 18 mm immediately distal to the previously implanted stent in the LAD. The patient refused any further intervention and was treated with aggressive medical management. Eighteen months have now passed, and the patient has been stable without further cardiac events or complaints.